A patient with a fractured coracoid process in association with a dislocation of the shoulder is reported. The fracture was not recognised initially, and early mobilisation was encouraged; the widely separated fracture did not heal and a painful pseudarthrosis developed. We believe that this association may not be as rare as generally supposed, and emphasise the importance of careful clinical examination in patients with shoulder dislocation. If a coracoid fracture is suspected, lateral or oblique radiographs should be taken to confirm the diagnosis. A further radiograph after reduction is a useful precaution.